Individual
THERESA ANN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2660 NE HIGHWAY 20 STE 610, BEND, OR 97701-6403
(910) 388-7958
Mailing address
2660 NE HIGHWAY 20 STE 610, BEND, OR 97701-6403
(910) 388-7958
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
175T00000X
Peer Specialist
Primary
—
OR
Other
Enumeration date
02/23/2026
Last updated
05/08/2026
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